Anal cancer is not considered an AIDS-defining malignancy (ADM). Nevertheless, the frequency of both anal intraepithelial neoplasia and invasive squamous cell carcinoma of the anus continues to increase in the HIV/AIDS population. As in cervical cancer, an ADM, numerous studies have established a causal relationship between high-risk types of human papillomavirus (HPV) infection and anal cancer [1]. In cervical cancer, the diagnosis is typically established at or near the time of HIV diagnosis [2]. The goal of this study was to evaluate and ascertain the interval from HIV diagnosis to anal cancer diagnosis.

In all 25 patients, anal cancer was biopsy-proven between 1 and 25 years after a diagnosis of HIV infection, with a mean of 11.43 years (Table 1). Greater than 95% of patients were compliant on antiretroviral therapy at the time of cancer diagnosis. This study identified a considerable delay in anal cancer diagnosis in all cases (Figure 1).

Table 1

:

Years elapsed from HIV diagnosis to anal cancer diagnosis

# of patients/ Years elapsed

Cumulative number of patients

1

1

1

2

1

2

3

0

2

4

1

3

5

2

5

6

0

5

7

2

7

8

2

9

9

1

10

10

1

11

11

2

13

12

0

13

13

2

15

14

2

17

15

2

19

16

2

21

17

1

22

18

0

22

19

0

22

20

0

22

21

2

24

22

0

24

23

0

24

24

1

25

25

0

25

Figure 1

Delay in anal cancer diagnosis in years by cumulative number of patients

The frequency of anal cancer within the HIV/AIDS population continues to increase despite effective antiretroviral therapy. This study reveals that unlike cervical cancer as an ADM, there is a frequent lag in identifying anal cancer among HIV patients. Given the known progression of HPV to cancer despite anti-retroviral therapy, it is imperative that health care providers include a closer examination of the perianal area on a regular and continuing basis. We believe that increased awareness of anal cancer in the setting of HIV/AIDS will lead to earlier recognition, timely treatment, as well as improved outcome and long-term survival.

Acknowledgements

This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.